Some metaphors have gone beyond cliché to parody, and should never be written in a medical article. They include at the end of the day, level playing field, and moving the goalposts. They are redolent of dodgy business practices.
There is no excuse for writing “at the end of the day” instead of the simpler in the end, or the single words eventually or ultimately. It can be difficult to stop oneself speaking the phrase, when it is—almost—forgivable. But it should never be written unless it means at the end of the day and is coincident with the beginning of the night. Even then it should be looked at carefully, in case it be interpreted metaphorically.
It’s not easy to look for the phrase in PubMed. All but the words end and day are stopwords in PubMed, so the phrase cannot be searched as “end of the day” in the way that “end result” can be searched. The words end and day are common: 50000 articles contain both of them. A quick scan of the first (which are temporally the last) 5000 showed that most uses of the phrase are in studies of eating patterns (human and animal), contact lens application, bird song, and so on, and are unambiguously literal. But there was one about patients getting diagnoses at the end of the day which meant eventually. There was another, confusingly about eating patterns, which concluded that at the end of the day—but meant in the end—the most important factors were self-monitoring and caloric input both on weekdays and weekends.
Looking at Ngram, the phrase’s prevalence changed little between 1920 and 1960, and then started to rise in the 70s. It has a bit more than doubled since then. The pattern is the same in the whole English corpus and in English fiction; Americans are a little more fond of the phrase than the British.
The level playing field was a later developer. Unusual until the 70s, it started to take off in the late 70s, and is now about 100 times more common than it was in 1980. Moving the goalposts follows the same time course but is two orders of magnitude less prevalent. This is mirrored in PubMed and, unlike at the end of the day, both playing fields and goalposts tend to occur in snappy titles: “Women in academic surgery: why is the playing field still not level?”; “End points in clinical trials: are they moving the goalposts?”
I admit this is personal taste, but I find these titles unimaginative, crass and unnecessary. Why not, “Why are women treated unfairly in academic surgery?”, “Are surrogate end points reliable in clinical trials?” (which was the topic of the article) instead of these tired, borrowed-from-business phrases? Whenever I read them, I see myself in a seminar room, watching an enthusiastic but shallow presenter turning the sheets of a flip chart while the audience look at their watches.
Neville Goodman is a retired consultant anaesthetist and a writer, and co-author of a book on medical English.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that my only competing interest is my co-authorship of a book about medical English.